Data Cart

Your data extract

0 variables
0 samples
View Cart



sa
[p. 1]


ADULT CORE
Section I -- IDENTIFICATION

FR: THE SAMPLE ADULT PERSON IS {sample adult name}. THE NEXT QUESTIONS MUST BE ANSWERED BY THIS PERSON. NO PROXIES ARE PERMITTED (EXCEPT WHEN THE SAMPLE ADULT RESPONDENT HAS A PHYSICAL OR MENTAL CONDITION WHICH PROHIBITS RESPONDING). PROBE AS NECESSARY TO DETERMINE THE AVAILABILITY OF {sample adult name}.
SADULT
(1) Available
(2) Not Available
(3) Physical or Mental condition prohibits responding
(7) Refused
(9) Don't know
Check Item AIDCCI1 :If the FAMILY respondent and Sample Adult are the same person, go to ACN.010; Else go to AID.030.
AID.030

FR: PLEASE VERIFY THE FOLLOWING INFORMATION ABOUT THE SAMPLE ADULT BEFORE PROCEEDING:

(1) Yes
(2) No
AIDVERF1 Gender = {male/female} Is it correct?
AIDVERF2 Age = {3 digit format} Is it correct?
AIDVERF3 Birthday = {spoken word format} Is it correct?

Check Item AIDCCI2: If AIDVERF_S = (2) go to AID.040; If AIDVERF_A = (2) go to AID.050; If AIDVERF_D = (2) go to AID.060; Else go to ACN.010. If no changes or when changes complete, go to next section -- Conditions

AID.040

FR: ASK IF APPROPRIATE; OTHERWISE, ENTER YOUR BEST GUESS OF THE PERSON=S SEX.

Is {sample adult name} Male or Female?
AIDSEX
(1) Male
(2) Female
(7) Refused
(9) Don't know

(Go to Check Item AIDCCI2)
[Update revised sex AIDSEX in SEX]

AID.050

How old is {sample adult name}?
AIDAGE
(000-120) 0-120 years old
(997) Refused
(999) Don't know

(Go to Check Item AIDCCI2)
[Update revised age AIDAGE in AGE]

[p. 2]

AID.060

What is {sample adult name}=s birthday?
AIDDOB_M
MONTH:

(01) January
(02) February
(03) March
(04) April
(05) May
(06) June
(07) July
(08) August
(09) September
(10) October
(11) November
(12) December
(97) Refused
(99) Don't Know
AIDDOB_D
DAY:

(01-31) 1-31
(97) Refused
(99) Don't Know
AIDDOB_Y
YEAR:

(0000-1999) 0-1999
(9997) Refused
(9999) Don't Know

(Go to Check Item AIDCCI2)

[Update revised birthdate in DOB_M, DOB_BDAY, and DOB_Y_P]
[Note: Variables in the AID section are used to verify information collected from the family respondent. They do no exist as separate variables in the analytic file.]

(Go to next section -- Conditions)

[p. 3]


Section II -- CONDITIONS


ACN.010

Now I am going to ask you about certain medical conditions.
Have you EVER been told by a doctor or other health professional that you had...Hypertension, also called high blood pressure?
HYPEV
(1) Yes
(2) No (ACN.031)
(7) Refused (ACN.031)
(9) Don't know (ACN.031)


ACN.020

Were you told on two or more DIFFERENT visits that you had hypertension, also called high blood pressure?
HYPDIFV
(1) Yes
(2) No
(7) Refused
(9) Don't know


ACN.020.010

DURING THE PAST 12 MONTHS, have you had hypertension, also called high blood pressure?
HYPYR
(1) Yes
(2) No
(7) Refused
(9) Don't know


ACN.031

FR: READ LEAD-IN IF NECESSARY:

Have you EVER been told by a doctor or other health professional that you had...
C1
(1) Yes
(2) No
(7) Refused
(9) Don't know
CHDEV... Coronary heart disease?
ANGEV... Angina, also called angina pectoris?
MIEV... A heart attack (also called myocardial infarction)?
HRTEV... Any kind of heart condition or heart disease (other than the ones I just asked about)?
STREV... A stroke?
EPHEV... Emphysema?


Check Item ACNCCI1: If C1@CHDEV=1 or C1@ANGEV=1 or C1@MIEV=1 or C1@HRTEV=1 or C1@STREV=1 or C1@EPHEV=1 goto C1YR; else goto CP.

ACN.031.010

DURING THE PAST 12 MONTHS, have you had ...?
C1YR
(1) Yes
(2) No
(7) Refused
(9) Don't know
CHDYR... Coronary heart disease?
ANGYR... Angina, also called angina pectoris?
MIYR... A heart attack (also called myocardial infarction)?
HRTYR... Any kind of heart condition or heart disease (other than the ones I just asked about)?
STRYR... A stroke?
EPHYR... Emphysema?

[p. 4]


ACN.031.020

Have you EVER been told by a doctor or other health professional that you had ...
CP
(1) Yes
(2) No
(7) Refused
(9) Don't know
HCHLEV ...High cholesterol
PCIRCEV ...Poor circulation in your legs
IRRHBEV ...Irregular heartbeats
CONHFEV ...Congestive heart failure


Check Item ACNCCI3:_If CP@HCHLEV=1 or CP@PCIRCEV=1 or CP@IRRHBEV=1 or CP@CONHFEV=1 goto CPYR; else goto AASMEV.

ACN.031.030

DURING THE PAST 12 MONTHS, have you had ... High cholesterol?
CPYR
(1) Yes
(2) No
(7) Refused
(9) Don't know
HCHLYR ...High cholesterol
PCIRCYR ...Poor circulation in your legs
IRRHBYR ...Irregular heartbeats
CONHFYR ...Congestive heart failure


ACN.080

FR: READ LEAD-IN IF NECESSARY:

Have you EVER been told by a doctor or other health professional that you had asthma?
AASMEV
(1) Yes
(2) No (ACN.110)
(7) Refused (ACN.110)
(9) Don't know (ACN.110)


ACN.085

Do you still have asthma?
AASSTILL
(1) Yes
(2) No
(7) Refused
(9) Don't know


ACN.090

During the PAST 12 MONTHS, have you had an episode of asthma or an asthma attack?
AASMYR
(1)Yes
(2) No
(7) Refused
(9) Don't know


Check item ACNCCI5:If AASSTILL =2,R,D AND AASMYR=2,R,D goto ULCEV; else, go to check itemACNCCI6.

Check item ACNCCI6:If AASMYR=2,R,D, goto AASMED; else go to AASMERYR

ACN.100

During the PAST 12 MONTHS, have you had to visit an emergency room or urgent care center because of asthma?
AASMERYR
(1) Yes
(2) No
(7) Refused
(9) Don't know

[p. 5]


ACN100.010

DURING THE PAST 12 MONTHS, HOW MANY DAYS were you UNABLE to work because of your asthma?

FR READ IF NECESSARY: FOR HOMEMAKERS THIS INCLUDES WORK AROUND THE HOUSE.
FR: ENTER 996 IF RESPONDENT UNABLE TO DO THIS ACTIVITY
AWZMSWK
(000) None
(001-365)1-365
(996) Unable to do this activity
(997) Refused
(999) Don't know
@A Days

[if @A ge (100) and @A ne (996)] display
{AWZMSWK@A} is an unusually large number.
Did you miss {AWZMSWK@A} days of work due to asthma?]

(1) Correct, proceed to next question
(2) Incorrect, change answer


ACN.100.020

Have you EVER taken the preventive kind of ASTHMA medicine used everyday to protect your lungs and keep you from having attacks? Include both oral medicine and inhalers. This is different from inhalers used for quick relief.
AASMED
(1) Yes
(2) No
(7) Refused
(9) Don't know


ACN.100.030

An asthma management plan is a printed form that tells when to change the amount or type of medicine, when to call the doctor for advice, and when to go to the emergency room.
Has a doctor or other health professional EVER given you an asthma management plan?

FR: READ IF NECESSARY: INCLUDE NURSES AND ASTHMA EDUCATORS
AASWMP
(1) Yes
(2) No
(7) Refused
(9) Don't know


ACN.100.040

Has a doctor or other health professional EVER advised you to change things in your home, school, or work to improve your asthma?
AAPENVLN
(1) Yes
(2) No
(3) Was told no changes needed
(7) Refused
(9) Don't know

[p. 6]


ACN.110

FR: READ LEAD-IN IF NECESSARY

Have you EVER been told by a doctor or other health professional that you had .......An ulcer? This could be a stomach, duodenal or peptic ulcer.
ULCEV
(1) Yes
(2) No (ACN.125.010)
(7) Refused (ACN.125.010)
(9) Don't know (ACN.125.010)


ACN.120

During the PAST 12 MONTHS, have you had an ulcer?
ULCYR
(1) Yes
(2) No
(7) Refused
(9) Don't know


ACN.125.010

Have you EVER been told by a doctor or other health professional that you had inflammatory bowel disease, irritable bowel, or constipation severe enough to require medication?
BOWLEV
(1) Yes
(2) No (ACN.125.030)
(7) Refused (ACN.125.030)
(9) Don't know (ACN.125.030)


ACN.125.020

DURING THE PAST 12 MONTHS, have you had inflammatory bowel disease, irritable bowel, or constipation severe enough to require medication?
BOWLYR
(1) Yes
(2) No
(7) Refused
(9) Don't Know


ACN.125.030

Have you EVER been told by a doctor or other health professional that you had...
CE
(1) Yes
(2) No
(7) Refused
(9) Don't know
THYREV ... a thyroid problem (hypo or hyper)?
URINPEV ...urinary problems such as incontinence, frequent or slow urination or infections?
ALLRFEV ...an allergic reaction to food or odors?
ALLRMEV ...an allergic reaction to medication severe enough to require treatment or medication?


Check Item ACNCCI7:If CE@THYREV=1 or CE@URINPEV=1 or CE@ALLRFEV=1 or CE@ALLRMEV, go to Check Item CEYR; else goto CN.

ACN.125.040

DURING THE PAST 12 MONTHS, have you had...?
CEYR
(1) Yes
(2) No
(7) Refused
(9) Don't know
THYRYR ... a thyroid problem (hypo or hyper)?
URINPYR ...urinary problems such as incontinence, frequent or slow urination or infections?
ALLRFYR ...an allergic reaction to food or odors?
ALLRMYR ...an allergic reaction to medication severe enough to require treatment or medication?

[p. 7]


ACN.125.050

Have you EVER been told by a doctor or other health professional that you had...
CN
(1) Yes
(2) No
(7) Refused
(9) Don't know
MSEV ... Multiple sclerosis?
PARKEV ... Parkinson's disease?
NEUROPEV ... Neuropathy?
SEIZEV ... Seizures?


ACN.125.060

DURING THE PAST 12 MONTHS have you ...
CSYR
(1) Yes
(2) No
(7) Refused
(9) Don't know
INSOMYR ... regularly had insomnia or trouble sleeping?
FATIGYR ... regularly had excessive sleepiness during the day?
PAINYR ... had recurring pain?


ACN.125.070

DURING THE PAST 12 MONTHS, have you been frequently depressed or anxious?
ANXDEPYR
(1) Yes
(2) No
(7) Refused
(9) Don't know


ACN.125.080

During the PAST 12 MONTHS have you had...
CDYR
(1) Yes
(2) No
(7) Refused
(9) Don't know
SPRAINYR ...any severe sprains or strains?
DENTLPYR ...dental pain?
SKINPYR ...skin problems?


ACN.130

FR: READ LEAD-IN IF NECESSARY

Have you EVER been told by a doctor or other health professional that you had...
Cancer or a malignancy of any kind?
CANEV
(1) Yes
(2) No (ACN.160)
(7) Refused (ACN.160)
(9) Don't know (ACN.160)

[p. 8]


ACN.140

What kind of cancer was it?

FR: MARK UP TO 3 KINDS. IF RESPONDENT OFFERS MORE THAN 3, CODE "96" IN THE FOURTH BOX. ENTER (N) FOR NO MORE.
CANKIND
(1) Bladder
(2) Blood
(3) Bone
(4) Brain
(5) Breast
(6) Cervix
(7) Colon
(8) Esophagus
(9) Gallbladder
(10) Kidney
(11) Larynx-windpipe
(12) Leukemia
(13) Liver
(14) Lung
(15) Lymphoma
(16) Melanoma
(17) Mouth/tongue/lip
(18) Ovary
(19) Pancreas
(20) Prostate
(21) Rectum
(22) Skin (non-melanoma)
(23) Skin (Don't know what kind)
(24) Soft Tissue (muscle or fat)
(25) Stomach
(26) Testis
(27) Throat - pharynx
(28) Thyroid
(29) Uterus
(30) Other
(96) More than 3 kinds
(97) Refused
(99) Don't know

[ ]
[ ]
[ ]
[ ]


ACN.150

How old were you when {this cancer} was first diagnosed?

(001-100) 1-100 years
(997) Refused
(999) Don't Know
CANAGE1 ...CANKIND1 cancer
CANAGE2 ...CANKIND2 cancer
CANAGE3 ...CANKIND3 cancer


ACN.160

[If Female, add:] Other than during pregnancy
Have you EVER been told by a doctor or health professional that you have diabetes or sugar diabetes?
DIBEV
(1) Yes
(2) No (ACN.201)
(3) Borderline (ACN.201)
(7) Refused (ACN.201)
(9) Don't know (ACN.201)


ACN.170

How old were you when a doctor FIRST told you that you had diabetes or sugar diabetes?
DIBAGE
(001-100) 1-100 years
(997) Refused
(999) Don't know


ACN.180

Are you NOW taking insulin?
INSLN
(1) Yes
(2) No
(7) Refused
(9) Don't know

[p. 9]


ACN.190

Are you NOW taking diabetic pills to lower your blood sugar? These are sometimes called oral agents or oral hypoglycemic agents.
DIBPILL
(1) Yes
(2) No
(7) Refused
(9) Don't know


ACN.201

During the PAST 12 MONTHS, have you been told by a doctor or other health professional that you had...
C2
(1) Yes
(2) No
(7) Refused
(9) Don't know
AHAYFYR ... Hay fever?
SINYR ... Sinusitis?
CBRCHYR ... Chronic bronchitis?
KIDWKYR ... Weak or failing kidneys? - Do not include kidney stones, bladder infections or incontinence.
LIVYR ... Any kind of liver condition?


ACN.250

The next questions refer to your joints. Please do NOT include the back or neck.
JNTSYMP
During THE PAST 30 days, have you had any symptoms of pain, aching, or stiffness in or around a joint?

(1) Yes
(2) No(ACN.290)
(7) Refused (ACN.290)
(9) Don't know (ACN.290)


ACN.260

FR: SHOW FLASHCARD A3
MARK ALL THAT APPLY. ENTER "N" FOR NO MORE

Which joints are affected?

[Card A3 depicts a human form]
Card A3
You may choose more than one

Front
Shoulders

(1) Right
(2) Left

Elbows

(3) Right
(4) Left

Hips

(5) Right
(6) Left

Wrists

(7) Right
(8) Left

Knees

(9) Right
(10) Left

Ankles

(11) Right
(12) Left

Toes

(13) Right
(14) Left
Back
Shoulders

(1) Right
(2) Left

Fingers, Thumb

(15) Right
(16) Left

Knees

(9) Right
(10) Left

( ) = joint

JMTHP
(1) Shoulder-right
(2) Shoulder-left
(3) Elbow-right
(4) Elbow-left
(5) Hip-right
(6) Hip-left
(7) Wrist-right
(8) Wrist-left
(9) Knee-right
(10) Knee-left
(11) Ankle-right
(12) Ankle-left
(13) Toes-right
(14) Toes-left
(15) Fingers/thumb -right
(16) Fingers/thumb -left
(17) Other joint not listed
(97) Refused
(99) Don't know


ACN.260.010

Please think about the past 30 days, keeping in mind all of your joint pain or aching and whether or not you have taken medication.
DURING THE PAST 30 DAYS, how bad was your joint pain ON AVERAGE?
Please answer on a scale of 0 to10 where 0 is no pain or aching and 10 is pain or aching as bad as it can be.
JNTPN
(00-10) 0-10
(97) Refused
(99) Don't know


ACN.270

Did your joint symptoms FIRST begin more than 3 months ago?
JNTCHR
(1) Yes
(2) No
(7) Refused
(9) Don't know

[p. 10]


ACN.280

Have you EVER seen a doctor or other health professional for these joint symptoms?
JNTHP
(1) Yes
(2) No
(7) Refused
(9) Don't know


ACN.290

Have you EVER been told by a doctor or other health professional that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?
ARTH1
(1) Yes
(2) No
(7) Refused
(9) Don't know


Check Item ACNCCI9 : IF JNTSYMP=1 or ARTH1=1 go to ARTHWT; else goto PAINECK.

ACN.290.010

Has a doctor or other health professional EVER suggested losing weight to help your arthritis or joint symptoms?
ARTHWT
(1) Yes
(2) No
(7) Refused
(9) Don't know


ACN.290.020

Has a doctor or other health professional EVER suggested physical activity or exercise to help your arthritis or joint symptoms?
ARTHPH
(1) Yes
(2) No
(7) Refused
(9) Don't know


ACN.290.030

Have you EVER taken an educational course or class to teach you how to manage problems related to your arthritis or joint symptoms?
ARTHCLS
(1) Yes
(2) No
(7) Refused
(9) Don't know


ACN.295

Are you now limited in any way in any of your usual activities because of arthritis or joint symptoms?
ARTHLMT
(1) Yes
(2) No
(7) Refused
(9) Don't know


ACN.295.010

In this next question we are referring to work for pay.
Do arthritis or joint symptoms now affect whether you work, the type of work you do, or the amount of work you do?
ARTHWRK
(1) Yes
(2) No
(7) Refused
(9) Don't know

[p. 11]


ACN.300

The following questions are about pain you may have experienced in the PAST THREE MONTHS.
Please refer to pain that LASTED A WHOLE DAY OR MORE. Do not report aches and pains that are fleeting or minor.

During the PAST THREE MONTHS, did you have.... Neck pain?
PAINECK
(1) Yes
(2) No
(7) Refused
(9) Don't know


ACN.310

FR: READ LEAD-IN IF NECESSARY
During the PAST THREE MONTHS, did you have...Low back pain?
PAINLB
(1) Yes
(2) No (ACN.331)
(7) Refused (ACN.331)
(9) Don't know (ACN.331)

ACN.320

Did this pain spread down either leg to areas below the knees?
PAINLEG
(1) Yes
(2) No
(7) Refused
(9) Don't know

FR: READ LEAD-IN IF NECESSARY

ACN.331

During the PAST THREE MONTHS, did you have...

(1) Yes
(2) No
(7) Refused
(9) Don't know
PAINFACE ... Facial ache or pain in the jaw muscles or the joint in front of the ear?
AMIGR ... Severe headache or migraine?

ACN.350

FR: HAND CALENDAR CARD.

These next questions are about your recent health during the TWO WEEKS outlined on that calendar.


Did you have a head cold or chest cold that started during those TWO WEEKS?
ACOLD2W
(1) Yes
(2) No
(7) Refused
(9) Don't know


ACN.360

Did you have a stomach or intestinal illness with vomiting or diarrhea that started during those TWO WEEKS?
AINTIL2W
(1) Yes
(2) No
(7) Refused
(9) Don't know


Check Item ACNCCI10: If SEX=1 goto ACNCCI14; else if SEX=2 AND AGE ge 50 go to Check Item ACNCCI11; else goto PREGNOW.

ACN.370

Are you currently pregnant?
PREGNOW
(1) Yes
(2) No
(7) Refused
(9) Don't know


Check item ACNCCI11: IF SEX=2 AND AGE le 55 go to MENSYR; else go to check item ACNCCI12.

ACN.370.010

DURING THE PAST 12 MONTHS have you had any menstrual problems such as heavy bleeding, bothersome cramping, or pre-menstrual syndrome (also called PMS)?
MENSYR
(1) Yes
(2) No
(7) Refused
(9) Don't know


Check item ACNCCI12: IF SEX=2 AND AGE =45-57 goto MENOYR; else go to check item ACNCCI13.

ACN.370.020

DURING THE PAST 12 MONTHS have you had any menopausal problems such as hot flashes, night sweats, or other menopausal symptoms?
MENOYR
(1) Yes
(2) No
(7) Refused
(9) Don't know


Check item ACNCCI13: IF SEX=2 goto GYNYR; else goto ACNCCI14.

ACN.370.030

DURING THE PAST 12 MONTHS have you had any gynecologic problems such as a vaginal infection, uterine fibroids, or infertility?
GYNYR
(1) Yes
(2) No
(7) Refused
(9) Don't know


Check item ACNCCI14: IF SEX=1 and AGE ge 40 goto PROSTYR; else go to HEARAID

ACN.370.040

DURING THE PAST 12 MONTHS have you had any men's health problems such as prostate trouble, or impotence?
PROSTYR
(1) Yes
(2) No
(7) Refused
(9) Don't know


ACN.410

These next questions are about your hearing, vision, and teeth.
Have you ever worn a hearing aid?
HEARAID
(1) Yes
(2) No(ACN.420)
(7) Refused (ACN.420)
(9) Don't know (ACN.420)

[p. 13]


ACN.410.010

DURING THE PAST 12 MONTHS, how often would you say you wore a hearing aid?
Would you say always, most of the time, some of the time, or none of the time?
HEARFREQ
(1) Always
(2) Most of the time
(3) Some of the time
(4) None of the time
(7) Refused
(9) Don't know


ACN.420

Which statement best describes your hearing without a hearing aid: good, a little trouble, a lot of trouble, deaf?
AHEARST
(1) Good (ACN.430)
(2) Little trouble
(3) Lot of trouble
(4) Deaf
(7) Refused (ACN.430)
(9) Don't know (ACN.430)


ACN.420.010

How old were you when you began to have ANY hearing loss in either ear?
HEARAGE
(1) At birth
(2) 0 through 2 years of age
(3) 3 through 5 years of age
(4) 6 through 18 years of age
(5) 19 through 44 years of age
(6) 45 through 64 years of age
(7) 65 or more years of age
(97) Refused
(99) Don't know


ACN.420.020

What was the MAIN cause of your hearing loss or deafness?
HEARCAUS
(1) Mother had German measles (rubella) during pregnancy
(2) At birth for genetic reason
(3) Present at birth for some other reason, not including infectious disease
(4) An infectious disease such as measles or meningitis
(5) An ear infection/multiple ear infections
(6) An ear injury
(7) Ear surgery
(8) Loud, brief noise from gunfire, blasts, or explosions
(9) Other noise from machinery, aircraft, power tools, loud music, appliances, Walkman personal stereos, hair dryers, etc.
(10) Getting older
(11) Some other cause? (ACN.420.030)
(97) Refused
(99) Don't Know

ACN.420.030

FR: ENTER SPECIFIED CAUSE OF HEARING LOSS OR DEAFNESS.
OTHCAUS ____________________________________________________

[p. 14]


ACN.430

Do you have any trouble seeing, even when wearing glasses or contact lenses?
AVISION
(1) Yes
(2) No (ACN.440.010)
(7) Refused (ACN.440.010)
(9) Don't know (ACN.440.010)


ACN.440

Are you blind or unable to see at all?
ABLIND
(1) Yes
(2) No
(7) Refused
(9) Don't know


ACN.440.010

Have you EVER been told by a doctor or other health professional that you had...
VIM
(1) Yes
(2) No
(7) Refused
(9) Don't know
DIBREV ...Diabetic retinopathy?
CATAREV ...Cataracts?
GLAUCEV ...Glaucoma?
MACDEV ...Macular degeneration?


Check Item ACNCCI15: If VIM@DIBREV=1 or VIM@CATAREV=1 or VIM@GLAUCEV=1 or VIM@MACDEV=1 goto VIMYR; else goto Check item ACNCCI17.

ACN.440.020

DURING THE PAST 12 MONTHS, have you had...?
VIMYR
(1) Yes
(2) No
(7) Refused
(9) Don't know
DIBRYR ...Diabetic retinopathy?
CATARYR ...Cataracts?
GLAUCYR ...Glaucoma?
MACDYR ...Macular degeneration


Check Item ACNCCI17: If AVISION=1 or DIBRYR=1 or CATARYR=1 or GLAUCYR=1 or MACDYR=1 then goto AVISREH; else goto ACNCCI18]


ACN.440.030

Do you use any vision rehabilitation services, such as job training, counseling, or training in daily living skills and mobility?
AVISREH
(1) Yes
(2) No
(7) Refused
(9) Don't know


ACN.440.040

Do you use any adaptive devices such as telescopic or other prescriptive lenses, magnifiers, large print or talking materials, CCTV, white cane, or guide dog?
AVISDEV
(1) Yes
(2) No
(7) Refused
(9) Don't know

Check item ACNCCI18: IF ABLIND=1, goto ACNCCI19; else goto AVDF
[p. 15]


ACN.440.050

Even when wearing glasses or contacts lenses, because of your eyesight, how difficult is it for you...

FR: SHOW FLASHCARD A4.
Card A4
0. Not at all difficult
1. Only a little difficult
2. Somewhat difficult
3. Very difficult
4. Can't do at all
6. Do not do this activity
AVDF
(0) Not at all difficult
(1) Only a little difficult
(2) Somewhat difficult
(3) Very difficult
(4) Can't do at all
(6) Do not do this activity
(7) Refused
(9) Don't know
AVDFNWS ...To read ordinary print in newspapers?
AVDFCLS ...To do work or hobbies that require you to see well up close such as cooking, sewing, fixing things around the house, or using hand tools?
AVDFNIT ...To go down steps, stairs or curbs in dim light or at night?
AVDFDRV ...To drive during daytime in familiar places?
AVDFPER ...To notice objects off to the side while you are walking along?
AVDFCRD ...To find something on a crowded shelf?


Check Item ACNCCI19: IF EVERWRK=2, 7, 9 go to AVISEXAM; else go to AVISWRIN.

ACN.440.060

Have you EVER had an eye injury that occurred at your place of work that caused you to miss at least one day of work?

FR: READ IF NECESSARY: THIS DOES NOT INCLUDE WORK AROUND THE HOUSE.
AVISWRIN
(1) Yes
(2) No
(7) Refused
(9) Don't know


ACN.440.070

When was the last time you had an eye exam in which the pupils were dilated?
This would have made you temporarily sensitive to bright light.
AVISEXAM
(1) Less than 1 month
(2) 1 to 12 months
(3) 13 to 24 months
(4) More than 2 years
(5) Never
(7) Refused
(9) Don't know


ACN.440.080

Outside of work, do you participate in sports, hobbies, or other activities that can cause eye injury?
This includes activities such as baseball, basketball, mowing the lawn, woodworking, or working with chemicals.
AVISACT
(1) Yes
(2) No (ACN.451)
(7) Refused (ACN.451)
(9) Don't know (ACN.451)

DIBRYR ...Diabetic retinopathy?
CATARYR ...Cataracts?
GLAUCYR ...Glaucoma?
MACDYR ...Macular degeneration

Check Item ACNCCI17: If AVISION=1 or DIBRYR=1 or CATARYR=1 or GLAUCYR=1 or MACDYR=1 then goto AVISREH; else goto ACNCCI18]
[p. 16]


ACN.440.090

When doing these activities, on average, do you wear eye protection always, most of the time, some of the time, or none of the time?
AVISPROT
(1) Always
(2) Most of the time
(3) Some of the time
(4) None of the time
(7) Refused
(9) Don't know


ACN.451

Have you lost all of your upper and lower natural (permanent) teeth?
LUPPRT
(1) Yes
(2) No
(7) Refused
(9) Don't know

Now I am going to ask you some questions about feelings you may have experienced over the PAST 30 DAYS.


ACN.471

FR: SHOW FLASHCARD A5.

During the PAST 30 DAYS, how often did you feel...
Card A5
1. All of the time
2. Most of the time
3. Some of the time
4. A little of the time
5. None of the time
C4
(1) ALL of the time
(2) MOST of the time
(3) SOME of the time
(4) A LITTLE of the time
(5) NONE of the time
(7) Refused
(9) Don't know
SAD ... So sad that nothing could cheer you up?
NERVOUS ... Nervous?
RES TLESS ... Restless or fidgety?
HOPELESS ... Hopeless?
EFFORT ... That everything was an effort?
WORTHLS ... Worthless?


Check item ACNCCI4 :If any of the responses to ACN.471 are 1 - 3, goto ACN.530; else goto next section

ACN.530

We just talked about a number of feelings you had during the PAST 30 DAYS. Altogether, how MUCH did these feelings interfere with your life or activities: a lot, some, a little, or not at all?
MHAMTMO
(1) A lot
(2) Some
(3) A little
(4) Not at all
(7) Refused
(9) Don't know

[p. 17]


Section III -- HEALTH STATUS AND LIMITATION OF ACTIVITIES


Part A -- Health Indicators

If DOINGLW1 eq (1,2,4) and if EVERWRK ne (2,R,D) goto AHS.040;
If DOINGLW1 eq (3,5) and if EVERWRK ne (2,R,D) goto AHS.030;
If DOINGLW1 eq (R,D) or EVERWRK eq (2,R,D) goto AHS.050

AHS.030

Although you did not work last week, did you have a job or business at any time in the PAST 12 MONTHS?
WRKLYR2
(1) Yes
(2) No (AHS.050)
(7) Refused (AHS.050)
(9) Don't know (AHS.050)


AHS.040

During the PAST 12 MONTHS, that is, since {12-month ref. date}, ABOUT how many days did you miss work at a job or business because of illness or injury (do not include maternity leave)?
WKDAYR
(0) None
(1-366) 1-366 Days
(997) Refused
(999) Don't know


AHS.050

During the PAST 12 MONTHS, that is, since {12-month ref. date}, ABOUT how many days did illness or injury keep you in bed more than half of the day? (Include days while an overnight patient in a hospital).
BEDDAYR
(0) None
(1-366) 1-366 Days
(997) Refused
(999) Don't know


AHS.060

Compared with 12 MONTHS AGO, would you say your health is better, worse, or about the same?
AHSTATYR
(1) Better
(2) Worse
(3) About the same
(7) Refused
(9) Don't know

[p. 18]

Part B -- Limitation of Activities


AHS.070

Do you now have any health problem that requires you to use special equipment, such as a cane, a wheelchair, a special bed, or a special telephone?
SPECEQ
(1) Yes
(2) No
(7) Refused
(9) Don't know


The next questions ask about difficulties you may have doing certain activities because of a HEALTH PROBLEM. By "health problem" we mean any physical, mental, or emotional problem or illness (not including pregnancy).

AHS.091

FR: SHOW FLASHCARD A7. [Survey indicates A7, correct card is A4]

By yourself, and without using any special equipment, how difficult is it for you to...

(0) NOT AT ALL DIFFICULT
(1) ONLY A LITTLE DIFFICULT
(2) SOMEWHAT DIFFICULT
(3) VERY DIFFICULT
(4) CAN'T DO AT ALL
(6) DO NOT DO THIS ACTIVITY
(7) Refused
(9) Don't Know
Card A4
0. Not at all difficult
1. Only a little difficult
2. Somewhat difficult
3. Very difficult
4. Can't do at all
6. Do not do this activity
FLWALK ... Walk a quarter of a mile - about 3 city blocks?
FLCLIMB ... Walk up 10 steps without resting?
FLSTAND ... Stand or be on your feet for about 2 hours?
FLSIT ... Sit for about 2 hours?
FLSTOOP ... Stoop, bend, or kneel?
FLREACH ... Reach up over your head?

AHS.141

FR: SHOW FLASHCARD A4.
FR: READ LEAD-IN IF NECESSARY:

By yourself, and without using any special equipment, how difficult is it for you to...

(0) NOT AT ALL DIFFICULT
(1) ONLY A LITTLE DIFFICULT
(2) SOMEWHAT DIFFICULT
(3) VERY DIFFICULT
(4) CAN'T DO AT ALL
(6) DO NOT DO THIS ACTIVITY
(7) Refused
(9) Don't Know
Card A4
0. Not at all difficult
1. Only a little difficult
2. Somewhat difficult
3. Very difficult
4. Can't do at all
6. Do not do this activity
FLGRASP ...Use your fingers to grasp or handle small objects?
FLCARRY ... Lift or carry something as heavy as 10 pounds such as a full bag of groceries?
FLPUSH ... Push or pull large objects like a living room chair?

AHS.171

FR: SHOW FLASHCARD A7. [Survey indicates A7, correct card is A4]
FR: READ LEAD-IN IF NECESSARY:

By yourself, and without using any special equipment, how difficult is it for you to...

(0) NOT AT ALL DIFFICULT
(1) ONLY A LITTLE DIFFICULT
(2) SOMEWHAT DIFFICULT
(3) VERY DIFFICULT
(4) CAN'T DO AT ALL
(6) DO NOT DO THIS ACTIVITY
(7) Refused
(9) Don't Know
Card A4
0. Not at all difficult
1. Only a little difficult
2. Somewhat difficult
3. Very difficult
4. Can't do at all
6. Do not do this activity
FLSHOP ...Go out to things like shopping, movies, or sporting events?
FLSOCL ...Participate in social activities such as visiting friends, attending clubs and meetings, going to parties?
FLRELAX ...Do things to relax at home or for leisure (reading, watching TV, sewing, listening to music)?
Check item AHSCCI3 : If AHS.091, AHS.141, or AHS.171 equals (1-4) go to AHS.200; else go to the next section - HEALTH BEHAVIORS.

[p. 20]


AHS.200

[IF 3 OR LESS CONDITIONS MENTIONED]
What condition or health problem causes you to have difficulty with {names of up to 3 specified activities/these activities}?

[Else]
What condition or health problem causes you to have difficulty with these activities?

FR: SHOW FLASHCARD A6. MARK ALL THAT APPLY, BUT DO NOT PROBE. ENTER (M) FOR CONDITIONS NOT ON THE FLASHCARD. ENTER (N) FOR NO MORE.
Card A6
You may choose more than one

1. Vision/problem seeing
2. Hearing problem
3. Arthritis/rheumatism
4. Back or neck problem
5. Fracture, bone/joint injury
6. Other injury
7. Heart problem
8. Stroke problem
9. Hypertension/high blood pressure
10. Diabetes
11. Lung/breathing problem
12. Cancer
13. Birth defect
14. Mental retardation
15. Other developmental problem (e.g., cerebral palsy)
16. Senility
17. Depression/anxiety/emotional problem
18. Weight problem
Other impairment/problem
AFLHCA1 (1) Vision/problem seeing
AFLHCA2 (2) Hearing problem
AFLHCA3 (3) Arthritis/rheumatism
AFLHCA4 (4) Back or neck problem
AFLHCA5 (5) Fractures, bone/joint injury
AFLHCA6 (6) Other injury
AFLHCA7 (7) Heart problem
AFLHCA8 (8) Stroke problem
AFLHCA9 (9) Hypertension/high blood pressure
AFLHCA10 (10) Diabetes
AFLHCA11 (11) Lung/breathing problem (e.g. asthma and emphysema)
AFLHCA12 (12) Cancer
AFLHCA13 (13) Birth defect
AFLHCA14 (14) Mental retardation
AFLHCA15 (15) Other developmental problem (e.g. cerebral palsy)
AFLHCA16 (16) Senility
AFLHCA17 (17) Depression/anxiety/emotional problem
AFLHCA18 (18) Weight problem
(97) Refused
(99) Don't know
(M) More conditions (AHS.200)

AHS.200

(19) Missing limbs (fingers, toes or digits), amputee
(20) Kidney, bladder or renal problems
(21) circulation problems (including blood clots)
(22) Benign tumors, cysts
(23) Fibromyalgia, lupus
(24) Osteoporosis, tendonitis
(25) Epilepsy, seizures
(26) Multiple Sclerosis (MS), Muscular Dystrophy (MD)
(27) Polio (myelitis), paralysis, Para/quadriplegia
(28) Parkinson=s disease, other tremors
(29) Other nerve damage, including carpal tunnel syndrome
(30) Hernia
(31) Ulcer
(32) Varicose veins, hemorrhoids
(33) Thyroid problems, Graves=disease, gout
(34) Knee problems [(not arthritis (03), not joint injury (05)]
(35) Migraine headaches (not just headaches)
(36) Other impairment/problem (specify one)
(37) Other impairment/problem (specify one)
(97) Refused
(99) Don't know

If answers = 1-37 then go to AHS.300; Else go to end of section.

FR: SPECIFY CONDITION CAUSING LIMITATION. THIS SHOULD BE THE NAME OF A SPECIFIC CONDITION THAT IS NOT ON THE CONDITION LIST.
AFLSPEC1 Condition: __________________________________________
FR: SPECIFY CONDITION CAUSING LIMITATION. THIS SHOULD BE THE NAME OF A SPECIFIC CONDITION THAT IS NOT ON THE CONDITION LIST.
AFLSPEC2 Condition: __________________________________________


AHS.300

How long have you had {condition AFLHCA}?
ALTIME1
[ ] NUMBER:

(01-94) 1-94(97) Refused
(95) 95+(99) Don't know
(96) Since birth
ALUNIT1
[ ] TIME PERIOD:

(1) Days(6) Since birth
(2) Weeks(7) Refused
(3) Months(9) Don't know
(4) Years

[AHS.300 - AHS.336 are asked for each condition reported in AHS.200]

(Go to next section)
[p. 22]


Section IV - HEALTH BEHAVIORS

Part A - Tobacco

These next questions are about cigarette smoking.

AHB.010

Have you smoked at least 100 cigarettes in your ENTIRE LIFE?
SMKEV
(1) Yes
(2) No (AHB.090)
(7) Refused (AHB.090)
(9) Don't know (AHB.090)


AHB.020

How old were you when you FIRST started to smoke fairly regularly?

FR: IF LESS THAN 6 YEARS OLD, ENTER "6"
SMKREG
(06-94) 6-94 years of age
(95) 95 years or older
(96) Never smoked regularly
(97) Refused
(99) Don't know


AHB.030

Do you NOW smoke cigarettes every day, some days or not at all?
SMKNOW
(1) Every day (AHB.050)
(2) Some days (AHB.060)
(3) Not at all (AHB.040)
(7) Refused (AHB.060)
(9) Don't know (AHB.060)


AHB.040

How long has it been since you quit smoking cigarettes?
SMKQTNO
[ ] NUMBER:

(01-94) 1-94
(95) 95+
(97) Refused (AHB.090)
(99) Don't know (AHB.045)
SMKQTTP
[ ] TIME PERIOD:

(1) Days
(2) Weeks
(3) Months
(4) Years
(7) Refused
(9) Don't know


AHB.045

Have you quit smoking since {current month, 1 year ago}?
SMKQTD
(1) Yes
(2) No
(7) Refused
(9) Don't know

(Go to AHB.090)

[p. 23]


AHB.050

On the average, how many cigarettes do you now smoke a day?

FR: IF LESS THANA1", ENTERA1"
CIGSDA1
(01-94) 1-94 cigarettes
(95) 95+ cigarettes
(97) Refused
(99) Don't know

(Go to AHB.080)


AHB.060

On how many of the PAST 30 DAYS did you smoke a cigarette?
CIGDAMO
(00) None (AHB.080)
(1-30) 1-30 Days (AHB.070)
(99) Don't know (AHB.070)
(97) Refused (AHB.070)


AHB.070

On the average, when you smoked during the PAST 30 DAYS, about how many cigarettes did you smoke a day?

FR: IF LESS THANA1", ENTERA1"
CIGSDA2
(01-94) 1-94 cigarettes
(95) 95+ cigarettes
(97) Refused
(99) Don't know


AHB.080

During the PAST 12 MONTHS, have you stopped smoking for more than one day BECAUSE YOU WERE TRYING TO QUIT SMOKING?
CIGQTYR
(1) Yes
(2) No
(7) Refused
(9) Don't know

[p. 24]

Part B - Leisure-time physical activity


The next questions are about physical activities (exercises, sports, physically active hobbies...) that you may do in your LEISURE time.


AHB.090

How often do you do VIGOROUS activities for AT LEAST 10 MINUTES that cause HEAVY sweating or LARGE increases in breathing or heart rate?

FR: IF NECESSARY, PROMPT WITH: HOW MANY TIMES PER DAY, PER WEEK, PER MONTH, OR PER YEAR DO YOU DO THESE ACTIVITIES?
VIGNO
[ ] NUMBER:

(000) Never (AHB.110)
(001-995) 1-995 times
(996) Unable to do this type activity (AHB.110)
(997) Refused (AHB.110)
(999) Don't know (AHB.110)
VIGTP
[ ] TIME PERIOD:

(0) Never
(1) Day
(2) Week
(3) Month
(4) Year
(6) Unable to do this type activity
(7) Refused
(9) Don't know

AHB.100

About how long do you do these vigorous activities each time?
VIGLNGNO
[ ] NUMBER:

(001-995) 1-995
(997) Refused (AHB.110)
(999) Don't know (AHB.108)
VIGLNGTP
[ ] TIME PERIOD:

(1) Minutes (AHB.110)
(2) Hours (AHB.110)
(7) Refused (AHB.110)
(9) Don't know (AHB.108)

AHB.108

Each time you do these vigorous activities, do you do them 20 minutes or more, or less than 20 minutes?
VIGLONGD
(1) Less than 20 minutes
(2) 20 minutes or more
(7) Refused
(9) Don't know

[p. 25]


AHB.110

How often do you do LIGHT OR MODERATE activities for AT LEAST 10 MINUTES that cause ONLY LIGHT sweating or a SLIGHT to MODERATE increase in breathing or heart rate?

FR: IF NECESSARY, PROMPT WITH: HOW MANY TIMES PER DAY, PER WEEK, PER MONTH, OR PER YEAR DO YOU DO THESE ACTIVITIES?
MODNO
[ ] NUMBER:

(000) Never (AHB.130)
(001-995) 1-995 times
(996) Unable to do this type activity (AHB.130)
(997) Refused (AHB.130)
(999) Don't know (AHB.130)
MODTP
[ ] TIME PERIOD:

(0) Never
(1) Day
(2) Week
(3) Month
(4) Year
(6) Unable to do this type activity
(7) Refused
(9) Don't know

AHB.120

About how long do you do these light or moderate activities each time?
MODLNGNO
[ ] NUMBER:

(001-995) 1-995
(997) Refused (AHB.130)
(999) Don't know (AHB.128)
MODLNGTP
[ ] TIME PERIOD:

(1) Minutes (AHB.130)
(2) Hours (AHB.130)
(7) Refused (AHB.130)
(9) Don't know (AHB.128)

AHB.128

Each time you do these light or moderate activities, do you do them 20 minutes or more, or less than 20 minutes?
MODLONGD
(1) Less than 20 minutes
(2) 20 Minutes or more
(7) Refused
(9) Don't know

[p. 26]


AHB.130

How often do you do physical activities specifically designed to STRENGTHEN your muscles such as lifting weights or doing calisthenics? (Include all such activities even if you have mentioned them before.)

FR: IF NECESSARY, PROMPT WITH: HOW MANY TIMES PER DAY, PER WEEK, PER MONTH, OR PER YEAR DO YOU DO THESE ACTIVITIES?
STRNGNO
[ ] NUMBER:

(000) Never
(001-995) 1-995 times
(996) Unable to do this type activity
(997) Refused
(999) Don't know
STRNGTP
[ ] TIME PERIOD:

(0) Never
(1) Day
(2) Week
(3) Month
(4) Year
(6) Unable to do this activity
(7) Refused
(9) Don't know

[p. 27]

PART C - Alcohol


These next questions are about drinking alcoholic beverages. Included are liquor such as whiskey or gin, beer, wine, wine coolers, and any other type of alcoholic beverage.

AHB.140

In ANY ONE YEAR, have you had at least 12 drinks of any type of alcoholic beverage?
ALC1YR
(1) Yes (AHB.160)
(2) No (AHB.150)
(7) Refused (AHB.150)
(9) Don't know (AHB.150)


AHB.150

In your ENTIRE LIFE, have you had at least 12 drinks of any type of alcoholic beverage?
ALCLIFE
(1) Yes
(2) No (AHB.190)
(7) Refused (AHB.190)
(9) Don't know (AHB.190)


AHB.160

In the PAST YEAR, how often did you drink any type of alcoholic beverage?

FR: IF NECESSARY, PROMPT WITH:A HOW MANY DAYS PER WEEK, PER MONTH, OR PER YEAR DID YOU DRINK? @
ALC12MNO
[ ] NUMBER:

(000) Never (AHB.190)
(001-365) 1-365 days
(997) Refused (AHB.190)
(999) Don't know (AHB.170)
ALC12MTP
[ ] TIME PERIOD:

(0) Never/None (AHB.190)
(1) Week (AHB.170)
(2) Month (AHB.170)
(3) Year (AHB.170)
(7) Refused (AHB.190)
(9) Don't know (AHB.170)


AHB.170

In the PAST YEAR, on those days that you drank alcoholic beverages, on the average, how many drinks did you have?

FR: IF LESS THAN 1 DRINK, ENTER A1"
ALCAMT
(01-94) 1-94 drinks
(95) 95+ drinks
(97) Refused
(99) Don't know

[p. 28]


AHB.180

In the PAST YEAR, on how many DAYS did you have 5 or more drinks of any alcoholic beverage?

FR: IF NECESSARY, PROMPT WITH: HOW MANY DAYS PER WEEK, PER MONTH, OR PER YEAR DID YOU HAVE 5 OR MORE DRINKS IN A SINGLE DAY?
ALC5UPNO
[ ] NUMBER:

(000) Never/None (AHB.190)
(001-365) 1-365 days
(997) Refused (AHB.190)
(999) Don't know (AHB.190)
ALC5UPTP
[ ] TIME PERIOD:

(0) Never/None
(1) Week
(2) Month
(3) Year
(7) Refused
(9) Don't know




AHB.190

How tall are you without shoes?
AHEIGHTF
FEET:

(02-07) 2-7 feet
(97) Refused
(99) Don't know
(M) Reported in metric (AHB.195)

AHB.190B

AHEIGHTI
INCHES:

(00-11) 0-11 inches
(97) Refused
(99) Don't know

(Go to AHB.200)

FR: ENTERAM@ TO RECORD METRIC MEASUREMENTS

AHB.195

AHEIGHTM
METERS:

(0-2) 0-2 meters
(7) Refused
(9) Don't know
AHEIGHTC
CENTIMETERS:

(000-241) 0-241 centimeters
(997) Refused
(999) Don't know

[p. 29]


AHB.200

How much do you weigh without shoes?
AWEIGHTP
POUNDS:

(050-500) 50-500 pounds (Go to next section)
(997) Refused (Go to next section)
(999) Don't know (Go to next section)
(M) Reported in metric (AHB.205)

FR: ENTER "M" TO RECORD METRIC MEASUREMENTS

AHB.205

WT_KG
KILOGRAMS:

(0227-2268) 22.7-226.8 kilograms
(9997) Refused
(9999) Don't know



(Goto next section--Health Care Access and Utilization)
[p. 30]


Section V - HEALTH CARE ACCESS AND UTILIZATION

Part A - Access to Care

The next questions are about health care.

AAU.020

Is there a place that you USUALLY go to when you are sick or need advice about your health?
AUSUALPL
(1) Yes (AAU.030)
(2) There is NO place (AAU.037)
(3) There is MORE THAN ONE place (AAU.030)
(7) Refused (AAU.037)
(9) Don't know (AAU.037)


AAU.030

[If AAU.020 equals (1) read:]
APLKIND
What kind of place is it - a clinic, doctor's office, emergency room, or some other place?

[If AAU.020 equals (3) read:]
What kind of place do you go to most often - a clinic, doctor's office, emergency room, or some other place?

(1) Clinic or health center (AAU.035)
(2) Doctor's office or HMO (AAU.035)
(3) Hospital emergency room (AAU.035)
(4) Hospital outpatient department (AAU.035)
(5) Some other place (AAU.035)
(6) Doesn't go to one place most often (AAU.037)
(7) Refused (AAU.037)
(9) Don't know (AAU.037)


AAU.035

Is that {full name from AAU.030 APLKIND} the same place you USUALLY go when you need routine or preventive care, such as a physical examination or check up?
AHCPLROU
(1) Yes (AAU.040)
(2) No (AAU.037)
(7) Refused (AAU.037)
(9) Don't know (AAU.037)


AAU.037

What kind of place do you USUALLY go to when you need routine preventive care, such as a physical examination or check-up?
AHCPLKND
(0) Doesn't get preventive care anywhere
(1) Clinic or health center
(2) Doctor's office or HMO
(3) Hospital emergency room
(4) Hospital outpatient department
(5) Some other place
(6) Doesn't go to one place most often
(7) Refused
(9) Don't know


Check item AAUCCI1: If AAU.020 equals 2, 7, or 9, then go to AAU.061; else go to AAU.040.

AAU.040

At any time in the PAST 12 MONTHS did you CHANGE the place(s) to which you USUALLY go for health care?
AHCCHGYR
(1) Yes (AAU.050)
(2) No (AAU.061)
(7) Refused (AAU.061)
(9) Don't know (AAU.061)

AAU.050

Was this change for a reason related to health insurance?
AHCCHGHI
(1) Yes
(2) No
(7) Refused
(9) Don't know


AAU.061

There are many reasons people delay getting medical care. Have you delayed getting care for any of the following reasons in the PAST 12 MONTHS?

(1) Yes
(2) No
(7) Refused
(9) Don't know
AHCDLYR1 ...You couldn't get through on the telephone.
AHCDLYR2 ...You couldn't get an appointment soon enough.
AHCDLYR3 ...Once you get there, you have to wait too long to see the doctor.
AHCDLYR4 ...The (clinic/doctor's office) wasn't open when you could get there.
AHCDLYR5 ...You didn't have transportation.


AAU.111

During the PAST 12 MONTHS, was there any time when you needed any of the following but didn't get it because you couldn't afford it?

(1) Yes
(2) No
(7) Refused
(9) Don't know
AHCAFYR1 ...Prescription medicines
AHCAFYR2 ...Mental health care or counseling
AHCAFYR3 ...Dental care (including check-ups)
AHCAFYR4 ...Eyeglasses

[p. 32]

Part B - Dental Care


AAU.135

FR: SHOW FLASHCARD A7.

About how long has it been since you last saw a dentist? Include all types of dentists, such as orthodontists, oral surgeons, and all other dental specialists, as well as dental hygienists.
Card A7
0. Never
1. 6 months or less
2. More than 6 months, but not more than 1 year ago
3. More than 1 year, but not more than 2 years ago
4. More than 2 years, but not more than 5 years ago
5. More than 5 years ago
ADNLONG2
(0) Never
(1) 6 months or less
(2) More than 6 months, but not more than 1 year ago
(3) More than 1 year, but not more than 2 years ago
(4) More than 2 years, but not more than 5 years ago
(5) More than 5 years
(7) Refused
(9) Don't know

[p. 33]

Part C - Health Care Provider Contacts


AAU.141

During the PAST 12 MONTHS, that is since {12 month ref.date}, have you seen or talked to any of the following health care providers about your own health?

(1) Yes
(2) No
(7) Refused
(9) Don't know
AHCSYR1 ...A mental health professional such as a psychiatrist, psychologist, psychiatric nurse, or clinical social worker?
AHCSYR2 ...An optometrist, ophthalmologist, or eye doctor (someone who prescribes eyeglasses)?
AHCSYR3 ...A foot doctor?
AHCSYR4 ...A chiropractor?
AHCSYR5 ...A physical therapist, speech therapist, respiratory therapist, audiologist, or occupational therapist?
AHCSYR6 ...A nurse practitioner, physician assistant, or midwife?


Check item AAUCCI7: If male goto AAU.211; If female goto AAU.200.

AAU.200

FR: READ LEAD-IN IF NECESSARY:

DURING THE PAST 12 MONTHS, that is since {12 month ref.date}, have you seen or talked to any of the following health care providers about your own health?

...A doctor who specializes in women's health (an obstetrician/gynecologist)?
AHCSYR7
(1) Yes
(2) No
(7) Refused
(9) Don't know


AAU.211

FR: READ LEAD-IN IF NECESSARY:

DURING THE PAST 12 MONTHS, that is since {12 month ref.date}, have you seen or talked to any of the following health care providers about your own health?
AHCSYR8 ...A medical doctor who specializes in a particular medical disease or problem (other than obstetrician/gynecologist, psychiatrist, or ophthalmologist)?
(1) Yes
(2) No
(7) Refused
(9) Don't know
AHCSYR9 ...A general doctor who treats a variety of illnesses (a doctor in general practice, family medicine, or internal medicine)?
(1) Yes (AAU.230)
(2) No (AAU.240)
(7) Refused (AAU.240)
(9) Don't know (AAU.240)

AAU.230

Does that doctor treat children and adults (a doctor in general practice or family medicine)?
AHCSYR10
(1) Yes
(2) No
(7) Refused
(9) Don't know

[p. 32]


AAU.240

FR: SHOW FLASHCARD A9. [A9 is incorrect, corect card is A8]

DURING THE PAST 12 MONTHS, HOW MANY TIMES have you gone to a HOSPITAL EMERGENCY ROOM about your own health? (This includes emergency room visits that resulted in a hospital admission.)
Card A8
0. None
1. 1
2. 2-3
3. 4-5
4. 6-7
5. 8-9
6. 10-12
7. 13-15
8. 16 or more
AHERNOY2
(00) None
(01) 1
(02) 2-3
(03) 4-5
(04) 6-7
(05) 8-9
(06) 10-12
(07) 13-15
(08) 16 or more
(97) Refused
(99) Don't know


AAU.250

DURING THE PAST 12 MONTHS, did you receive care AT HOME from a nurse or other health care professional?
AHCHYR
(1) Yes (AAU.260)
(2) No (AAU.280)
(7) Refused (AAU.280)
(9) Don't know (AAU.280)


AAU.260

During how many of the PAST 12 MONTHS did you receive care AT HOME from a health care professional?
AHCHMOYR
(01-12) months
(97) Refused
(99) Don't know


AAU.270

FR: SHOW FLASHCARD A10. [A10 is in correct, corect card is A9]

What was the total number of home visits received during {that month/those months}?
Card A9
1. 1
2. 2-3
3. 4-5
4. 6-7
5. 8-9
6. 10 -12
7. 13-15
8. 16 or more
AHCHNOY2
(01) 1
(02) 2-3
(03) 4-5
(04) 6-7
(05) 8-9
(06) 10-12
(07) 13-15
(08) 16 or more
(97) Refused
(99) Don't know


AAU.280

FR: SHOW FLASHCARD A9. [A9 is incorrect, A8 is the correct card]

DURING THE PAST 12 MONTHS, HOW MANY TIMES have you seen a doctor or other health care professional about your own health at a DOCTOR'S OFFICE, A CLINIC, OR SOME OTHER
PLACE? DO NOT INCLUDE TIMES YOU WERE HOSPITALIZED OVERNIGHT, VISITS TO HOSPITAL EMERGENCY ROOMS, HOME VISITS, DENTAL VISITS, OR TELEPHONE CALLS.
Card A8
0. None
1. 1
2. 2-3
3. 4-5
4. 6-7
5. 8-9
6. 10-12
7. 13-15
8. 16 or more
AHCNOYR2
(00) None
(01) 1
(02) 2-3
(03) 4-5
(04) 6-7
(05) 8-9
(06) 10-12
(07) 13-15
(08) 16 or more
(97) Refused
(99) Don't know

[p. 33]


AAU.290

DURING THE PAST 12 MONTHS, have you had SURGERY or other surgical procedures either as an inpatient or outpatient?

FR:(READ IF NECESSARY) THIS INCLUDES BOTH MAJOR SURGERY AND MINOR PROCEDURES SUCH AS SETTING BONES OR REMOVING GROWTHS.
ASRGYR
(1) Yes (AAU.300)
(2) No (Check item AAUCCI8)
(7) Refused (Check item AAUCCI8)
(9) Don't know (Check item AAUCCI8)


AAU.300

Including any times you may have already told me about, HOW MANY DIFFERENT TIMES have you had surgery during the PAST 12 MONTHS?

FR: ENTER 95 FOR 95 OR MORE TIMES.
ASRGNOYR
(01-94) 1-94 times
(95) 95+ times
(97) Refused
(99) Don't know


Check item AAUCCI8 :If the sample adult has had a doctor visit in the last two weeks as indicated in the family core FAU.180 = 1 and FAU.190 = the adult sample person, then AAU.305 = 1 and go to AAU.310; Else goto AAU.305.

AAU.305

FR: SHOW FLASHCARD A7.

About how long has it been since you last saw or talked to a doctor or other health care professional about your own health? Include doctors seen while a patient in a hospital.
Card A7
0. Never
1. 6 months or less
2. More than 6 months, but not more than 1 year ago
3. More than 1 year, but not more than 2 years ago
4. More than 2 years, but not more than 5 years ago
5. More than 5 years ago
AMDLONGR
(0) Never
(1) 6 months or less
(2) More than 6 months, but not more than 1 year ago
(3) More than 1 year, but not more than 2 years ago
(4) More than 2 years, but not more than 5 years ago
(5) More than 5 years ago
(7) Refused
(9) Don't know

[p. 36]

Part D - IMMUNIZATIONS


AAU.310

DURING THE PAST 12 MONTHS, have you had a flu shot? A flu shot is usually given in the fall and protects against influenza for the flu season.
SHTFLUYR
(1) Yes
(2) No
(7) Refused
(9) Don't know


AAU.320

Have you EVER had a pneumonia shot? This shot is usually given only once or twice in a person's lifetime and is different from the flu shot. It is also called the pneumococcal vaccine.
SHTPNUYR
(1) Yes
(2) No
(7) Refused
(9) Don't know


AAU.330

Have you EVER had chickenpox?
APOX
(1) Yes (AAU.340)
(2) No (AAU.350)
(7) Refused (AAU.350)
(9) Don't know (AAU.350)


AAU.340

Have you had chickenpox in the past 12 months?
APOX12MO
(1) Yes
(2) No
(7) Refused
(9) Don't know


AAU.350

Have you EVER had hepatitis?
AHEP
(1) Yes (AAU.370)
(2) No (AAU.360)
(7) Refused (AAU.360)
(9) Don't know (AAU.360)


AAU.360

Have you ever lived with someone who had hepatitis?
AHEPLIV
(1) Yes
(2) No
(7) Refused
(9) Don't know


AAU.370

Have you EVER received the hepatitis B vaccine?

FR: READ IF NECESSARY: This is given in three separate doses and has been available since 1991. It is recommended for newborn infants, adolescents, and people such as health care workers, who may be exposed to the hepatitis B virus.
SHTHEPB
(1) Yes (AAU.380)
(2) No (end section)
(7) Refused (end section)
(9) Don't know (end section)

AAU.380

Did you receive at least 3 doses of the hepatitis B vaccine, or less than 3 doses?
SHEPDOS
(1) Received at least 3 doses
(2) Received less than 3 doses
(7) Refused
(9) Don't know

(Go to next section)
[p. 37]


Section VI - DEMOGRAPHICS


Check item ASDCCI2 : If the family respondent is also the sample adult and DOINGLW1 eq (7, 9), go to WRKCOR; else go to WRKVER.

ASD.050

Earlier I recorded that in the last week you were {Fill answer code description from DOINGLW}.
Is that correct?
WRKVER
(1) Yes
(2) No
(7) Refused
(9) Don't know

If WRKVER eq (2) goto WRKCOR
else if DOINGLW1 eq (1, 2, 4) goto WHOWRK
else if DOINGLW1 eq (3, 5) goto EVERWRK

ASD.060

FR: VERIFY OR ASK

What is your correct working status?
WRKCOR
(1) Working for pay at a job or business
(2) With a job or business but not at work
(3) Looking for workfor work
(4) Working, but not for pay, at a job or business
(5) Not working at a job or business AND not looking
(7) Refused
(9) Don't know
NOTE: At this point, information from WRKCOR is used to update DOINGLW1 in FSD. "Corrected Employment Status Last Week", with the following values:

(1) Working for pay at a job or business
(2) With a job or business but not at work
(3) Looking for work
(4) Working, but not for pay, at a job or business
(5) Not working at a job or business AND not looking for work
(7) Refused
(9) Don't Know
If DOINGLW1 eq (2, 5) goto WHYNOWK2
else If DOINGLW1 eq (1, 4) goto WHOWRK
else If DOINGLW1 eq (3) goto EVERWRK
else goto next section

[p. 38]

ASD.065

What is the main reason you did not work last week?
WHYNOWK2
(01) Taking care of house or family
(02) Going to school
(03) Retired
(04) On a planned vacation from work
(05) On family or maternity leave
(06) Unable to work for health reasons
(07) On layoff
(08) Disabled
(09) Have job/contract;off season
(10) Other
(97) Refused
(99) Don't know

If DOINGLW1 eq (1,2,4) go to WHOWRK; else
If DOINGLW1 eq (3,5) go to EVERWRK

NOTE: At this point, information from WHYNOWRK in FSD and WHYNOWK2 is used to create WHYNOWK1.

ASD.066

Have you ever held a job or worked at a business?
EVERWRK
(1) Yes (goto ASD.070)
(2) No (goto ASD.180.010)
(7) Refused (goto ASD.180.010)
(9) Don't know (goto ASD.180.010)

If EVERWRK eq (1) or DOINGLW1 eq (1, 2, 4) goto WHOWRK; else goto next section.

ASD.070

[If DOINGLW1 eq (1) or DOINGLW1 eq (2) or DOINGLW1 eq (4)]
For whom did you work at your MAIN job or business? (Name of company, business, organization, or employer)

[If (EVERWRK eq (1) and WHYNOWK1 eq (3)) or AGE ge (65)]
Thinking about the job you held the longest, for whom did you work? (Name of company, business, organization, or employer)

[If EVERWRK eq (1) and WHYNOWK1 ne (3) and AGE lt (65)]
Thinking about the job you held most recently, for whom did you work? (Name of company, business, organization, or employer)
WHOWRK
Job or Business: _________________________________
(7) Refused
(9) Don't know

ASD.080

What kind of business or industry is this? (For example: TV and radio mgt., retail shoe store, State Department of Labor)
KINDIND
Kind of Business: _________________________________
(7) Refused
(9) Don't know

[p. 39]

ASD.090

What kind of work were you doing? (For example: farming, mail clerk, computer specialist.)
KINDWRK
Kind of Work: _________________________________________
(7) Refused
(9) Don't know

ASD.100

What were your most important activities on this job or business? (For example: sells cars, keeps account books, operates printing press.)
IMPACT
Activities: ______________________________________________
(7) Refused
(9) Don't know


ASD.110

FR: SHOW FLASHCARD A1

[If DOINGLW1 eq (1,2,4)]
Looking at the card, which of these best describes your current job or work situation?

[If (EVERWRK eq (1) and WHYNOWK1 eq (3)) or AGE ge (65)]
Looking at the card, which of these best describes the job you held for the longest time?

[If EVERWRK eq (1) and WHYNOWK1 ne (3) and AGE lt (65)]
Looking at the card, which of these best describes the job you held most recently?

FR: READ IF NECESSARY
Card A1
1. An employee of a PRIVATE company, business, or individual for wages, salary, or commission
2. A FEDERAL government employee
3. A STATE government employee
4. A LOCAL government employee
5. Self-employed in OWN business, professional practice or farm
6. Working WITHOUT PAY in family business or farm
WRKCAT
(1) An employee of a PRIVATE company, business, or individual for wages, salary, or commission
(2) A FEDERAL government employee
(3) A STATE government employee
(4) A LOCAL government employee
(5) Self-employed in OWN business, professional practice or farm
(6) Working WITHOUT PAY in family business or farm
(7) Refused
(9) Don't know

If WRKCAT eq (1, 2, 3, 4, 6, 7,9) go to LOCALL1; else If WRKCAT eq (5) goto BUSINC1

ASD.112

Is this business incorporated?
BUSINC1
(1) Yes
(2) No
(7) Refused
(9) Don't know

[p. 40]


ASD.120

FR: SHOW FLASHCARD A2

[If DOINGLW1 eq (1,2,4)]
Thinking about this MAIN job or business,

[If (EVERWRK eq (1) and WHYNOWK1 eq (3)) or AGE ge (65)]
Thinking about your last week at the job you held the longest,

[If EVERWRK eq (1) and WHYNOWK1 ne (3) and AGE lt (65)]
Thinking about your last week at the job you held most recently, how many people work(ed) at this location?

NOTE TO FR: "People" includes both full- and part-time employees; "location" refers to the street address of the workplace.
Card A2
1. 1-9 employees
2. 10-24 employees
3. 25-49 employees
4. 50-99 employees
5. 100-249 employees
6. 250-499 employees
7. 500-999 employees
8. 1000 employees or more
LOCALL1
(1) 1- 9 employees
(2) 10-24 employees
(3) 25-49 employees
(4) 50-99 employees
(5) 100-249 employees
(6) 250-499 employees
(7) 500-999 employees
(8) 1000 employees or more
(7) Refused
(9) Don't know

ASD.140

[If DOINGLW1 eq (1,2,4)]
About how long have you worked at this MAIN job or business?

[If (EVERWRK eq (1) and WHYNOWK1 eq (3)) or AGE ge (65)]
About how long did you work at the job you held the longest?

[If EVERWRK eq (1) and WHYNOWK1 ne (3) and AGE lt (65)]
About how long did you work at the job you held most recently?
WRKLONG1
NUMBER:

(001-365) 1-365
(997) Refused
(999) Don't know

If WRKLONG1 eq (997, 999) goto HOURPD;
else if WRKLONG1 eq (001-365) goto WRKLONG2
WRKLONG2
TIME PERIOD:

(1) Day(s)
(2) Week(s)
(3) Month(s)
(4) Year(s)
(7) Refused
(9) Don't Know

[p. 41]

Check Item: If WRKLONG2 eq 4 and WRKLONG1 ge AGE, goto WRKLOGN_EDIT; else go to HOURPD.
ASD.141

Number of years exceeds current age. Please verify entry.
WRKLOGN_EDIT
(1) Make correction
(2) Proceed

ASD.146

[If DOINGLW1 eq (1, 2, 4)]
Is this main job or business the job you have held for the longest?

[If (EVERWRK eq (1) and WHYNOWK1 eq (3)) or AGE lt (65)]
Was your most recently held job also the job you held the longest?
WRKLONGH
(1) Yes
(2) No
(7) Refused
(9) Don't know


ASD.150

[If DOINGLW1 eq (1,2,4)]
Are you paid by the hour at this MAIN job or business?

[If (EVERWRK eq (1) and WHYNOWK1 eq (3)) or AGE ge (65)]
Were you paid by the hour on this job you held the longest?

[If EVERWRK eq (1) and WHYNOWK1 ne (3) and AGE lt (65)]
Were you paid by the hour on this job you held most recently?
HOURPD
(1) Yes
(2) No
(7) Refused
(9) Don't know


ASD.160

[If DOINGLW1 eq (1,2,4)]
Do you have paid sick leave on this MAIN job or business?

[If (EVERWRK eq (1) and WHYNOWK1 eq (3)) or AGE ge (65)]
Did you ever have paid sick leave on this job you held the longest?

[If EVERWRK eq (1) and WHYNOWK1 ne (3) and AGE lt (65)]
Did you ever have paid sick leave on this job you held most recently?
PDSICK
(1) Yes
(2) No
(7) Refused
(9) Don't know

If DOINGLW1 eq (1, 2, 4) goto ONEJOB; else go to HOME50]
ASD.170

Do you have more than one job or business?
ONEJOB
(1) Yes
(2) No
(7) Refused
(9) Don't know

[p. 42]


The next question is about this home.

ASD.180.010

Was your home built before 1950?
HOME50
(1) Yes (ASD.180.020)
(2) No (goto A_DEMO_END)
(7) Refused ( goto A_DEMO_END)
(8) Don't know (ASD.180.020)


ASD.180.020

Has paint from this home EVER been analyzed for lead content?
LEADPNT
(1) Yes
(2) No
(7) Refused
(9) Don't know

(END OF SECTION)
[p. 43]


Section VII - AIDS


ADS.010

Now, I am going to ask about giving blood donations to a blood bank such as the American Red Cross.
Have you donated blood since March 1985?
BLDGV
(1) Yes (ADS.020)
(2) No (ADS.040)
(7) Refused (ADS.040)
(9) Don't know (ADS.040)


ADS.020

During the PAST 12 MONTHS, that is, since {12-month ref. date}, have you donated blood?
BLDG12M
(1) Yes
(2) No
(7) Refused
(9) Don't know


ADS.040

The next questions are about the test for HIV, (the virus that causes AIDS).

If ADS.010 equals (1) read:
Except for tests you may have had as part of blood donations, have you ever been tested for HIV?

Else read:
Have you ever been tested for HIV?
HIVTST
(1) Yes (ADS.060)
(2) No (ADS.050)
(7) Refused (ADS.110)
(9) Don't know (ADS.110)


ADS.050

FR: SHOW FLASHCARD A10.

I am going to show you a list of reasons why some people have not been tested for HIV, (the virus that causes AIDS). Which one of these would you say is the MAIN reason why you have not been tested?
Card A10
1. It's unlikely you've been exposed to HIV
2. You were afraid to find out if you were HIV positive (that you had HIV)
3. You didn't want to think about HIV or about being HIV positive
4. You were worried your name would be reported to the government if you tested positive
5. You didn't know where to get tested
6. You don't like needles
7. You were afraid of losing job, insurance, housing, friends, family, if people knew you were positive for AIDS infection
8. Some other reason
9. No particular reason
WHYTST
(01) It's unlikely you've been exposed to HIV; (ADS.110)
(02) You were afraid to find out if you were HIV positive (that you had HIV); (ADS.110)
(03) You didn't want to think about HIV or about being HIV positive; (ADS.110)
(04) You were worried your name would be reported to the government if you tested positive; (ADS.110)
(05) You didn't know where to get tested; (ADS.110)
(06) You Don't like needles; (ADS.110)
(07) You were afraid of losing job, insurance, housing, friends, family, if people knew you were positive for AIDS infection; (ADS.110)
(08) Some other reason; (ADS.055)
(09) No particular reason; (ADS.110)
(97) Refused; (ADS.110)
(99) Don't Know; (ADS.110)

ADS.055

What was the main reason why you have not been tested?.
WHYSPEC Main reason: ________________________________ (ADS.110)

[p. 44]


ADS.060

If ADS.020 equals (1) read:
Not including blood donations, in what month and year was your last test for HIV, (the virus that causes AIDS)?

Else read:
In what month and year was your last test for HIV, (the virus that causes AIDS)?

FR: Enter T for Time Period (ADS.061)
TST12M_M
[ ] MONTH:

(01) January
(02) February
(03) March
(04) April
(05) May
(06) June
(07) July
(08) August
(09) September
(10) October
(11) November
(12) December
(97) Refused (ADS.061)
(99) Don't know
TST12M_Y
[ ] YEAR:

(1880-2030) 1880-2030 (ADS.065)
(97) Refused (ADS.061)
(99) Don't know (ADS.061)

ADS.061

Was it:
TIMETST
(1) 6 months or less
(2) More than 6 months but not more than 1 year ago
(3) More than 1 year, but not more than 2 years ago
(4) More than 2 years, but not more than 5 years ago
(5) More than 5 years ago
(7) Refused
(9) Don't know


ADS.060.010

DURING THE PAST 12 MONTHS, how man times have you been tested for HIV, including times you did not get your results?
TSTTYR
(00) None
___ times
(97) Refused
(99) Don't know

[p. 45]


ADS.065

FR: SHOW FLASHCARD A14. [A14 is incorrect, the correct card is A11]

I am going to show you a list of reasons why some people have been tested for HIV, (the virus that causes AIDS).

If ADS.020 equals (1) read:
Not including your blood donations, which of these would you say was the MAIN reason for your last HIV test?

Else read:
Which of these would you say was the MAIN reason for your last HIV test?
Card A11
1. Someone suggested you should be tested
2. You might have been exposed through sex or drug use
3. You might have been exposed through your work or at work
4. You just wanted to find out if you were infected or not
5. For part of a routine medical check-up, or for hospitalization or surgical procedure
6. You were sick or had a medical problem
7. You were pregnant or delivered a baby
8. For health or life insurance coverage
9. For military induction, separation, or military service
10. For immigration
11. For marriage license or to get married
12. You were concerned you could give HIV to someone
13. You wanted medical care or new treatments if you tested positive
14. Some other reason
15. No particular reason
REATST
(01) Someone suggested you should be tested; (ADS.066)
(02) You might have been exposed through sex or drug use; (ADS.070)
(03) You might have been exposed through your work or at work; (ADS.070)
(04) You just wanted to find out if you were infected or not; (ADS.070)
(05) For part of a routine medical check-up, or for hospitalization or surgical procedure; (ADS.070)
(06) You were sick or had a medical problem; (ADS.070)
(07) You were pregnant or delivered a baby; (ADS.070)
(08) For health or life insurance coverage; (ADS.070)
(09) For military induction, separation, or military service; (ADS.070)
(10) For immigration; (ADS.070)
(11) For marriage license or to get married; (ADS.070)
(12) You were concerned you could give HIV to someone; (ADS.070)
(13) You wanted medical care or new treatments if you tested positive; (ADS.070)
(14) Some other reason. (ADS.069)
(15) No particular reasons. (ADS.070)
(97) Refused(ADS.070)
(99) Don't know (ADS.070)


ADS.066

Who suggested you should be tested - a doctor, nurse or other health care professional, a sex partner, someone at the health department, or someone else?
REASWHOR
(1) Doctor, nurse or other health care professional (ADS.070)
(2) Sex partner (ADS.070)
(3) Someone at health department (ADS.070)
(4) Family member or friend (ADS.070)
(5) Other (ADS.067)
(7) Refused (ADS.070)
(9) Don't know (ADS.070)

ADS.067

Who suggested you should be tested?
WHOSPEC Who: _____________________________________ (ADS.070)


ADS.069

What was the main reason for your last HIV test?
REASPEC Main reason: _____________________________________

[p. 46]


ADS.070

FR: SHOW FLASHCARD A15. [A15 is incorrect, the correct card is A12]

If ADS.010 equals (1) read:
Not including your blood donations, where did you have your last HIV test?

Else read:
Where did you have your last HIV test?
Card A12
1. Private doctor/HMO
2. AIDS clinic/counseling/testing site
3. Hospital, emergency room, outpatient clinic
4. Other type of clinic
5. Public health department
6. At home
7. Drug treatment facility
8. Military induction or military service site
9. Immigration site
10. In a correctional facility (jail or prison)
11. Other location
LASTST
(01) Private doctor/HMO (ADS.080)
(02) AIDS clinic/counseling/testing site (ADS.080)
(03) Hospital, emergency room, outpatient clinic (ADS.080)
(04) Other type of clinic (ADS.072)
(05) Public health department (ADS.080)
(06) At home (ADS.074)
(07) Drug treatment facility (ADS.080)
(08) Military induction or military service site (ADS.080)
(09) Immigration site (ADS.080)
(10) In a correctional facility (jail or prison) (ADS.080)
(11) Other location (ADS.076)
(97) Refused (ADS.080)
(99) Don't know/not sure (ADS.080)


ADS.072

What type of clinic did you go to for your last HIV test?
CLINTYP_C
(01) Family planning clinic
(02) Prenatal clinic
(03) Tuberculosis clinic
(04) STD clinic
(05) Community health clinic
(06) Clinic run by employer or insurance company
(07) Other
(97) Refused
(99) Don't know

(Goto ADS.080)

ADS.074

Was this test administered by a nurse or other health worker, or did you use a self-sampling kit?
WHOADM
(1) Nurse or health worker
(2) Self-sampling kit
(7) Refused
(9) Don't know

(Goto ADS.080)

ADS.076

Where did you have your last HIV test?

FR: THIS SHOULD BE A SPECIFIC LOCATION THAT IS NOT ON THE LIST.
LASTSPEC Location: ______________________________

[p. 47]


ADS.080

The last time you were tested, did you have to give your first and last names?
GIVNAM
(1) Yes
(2) No
(7) Refused
(9) Don't know


ADS.110

If ADS.040 equals (1) read:
Do you expect to have another test for HIV in the next 12 months, not including blood donations?

Else, read:
Do you expect to have a test for HIV in the next 12 months, not including blood donations?
EXTST12M
(1) Yes
(2) No
(7) Refused
(9) Don't know


ADS.140

What are your chances of GETTING HIV, (the virus that causes AIDS)? Would you say high, medium, low, or none?
CHNSADS
(1) High
(2) Medium
(3) Low
(4) None
(5) Already have HIV or AIDS
(7) Refused
(9) Don't know


ADS.150

FR: SHOW FLASHCARD A13.

Tell me if ANY of these statements is true for YOU. Do NOT tell me WHICH statement or statements are true for you. Just IF ANY of them are.

(a) You have hemo philia and have received clotting factor concentrations.
(b) You are a man who has had sex with other men, even just one time.
(c) You have taken street drugs by needle, even just one time.
(d) You have traded sex for money or drugs, even just one time.
(e) You have tested positive for HIV, (the virus that causes AIDS).
(f) You have had sex (even just one time) with someone who would answerAyes@ to any of these statements
Card A13
a. You have hemophilia and have received clotting factor concentrations
b. You are a man who has had sex with other men, even just one time
c. You have taken street drugs by needle, even just one time
d. You have traded sex for money or drugs, even just one time
e. You have tested positive for HIV, the virus that causes AIDS
f. You have had sex (even just one time) with someone who would answer "yes" to any of these statements
STMTRU
(1) Yes, at least one statement is true
(2) No, none of these statements are true
(7) Refused
(9) Don't know


Check item:If AGE ge or eq (50) goto ADS.200; else goto ADS.160

ADS.160

The next questions are about other sexually transmitted diseases or STDs. STDs are also known as venereal diseases or VD. Examples of STDs are gonorrhea, chlamydia (CLUH-MIH-DEE-UH), syphilis, herpes, and genital warts.

In the past five years, have you had an STD other than HIV or AIDS?

FR: IF ASKED, TELL RESPONDENT TO INCLUDE NEWLY CONTRACTED STDs AND RECURRING FLARE-UPS OF PREVIOUSLY CONTRACTED STDs.
STD
(1) Yes (ADS.170)
(2) No(ADS.200)
(7) Refused (ADS.200)
(9) Don't Know (ADS.200)

[p. 48]


ADS.170

The last time you had an STD other than HIV or AIDS, did you see a doctor or other health professional to get it checked?
STDDOC
(1)Yes (ADS.180)
(2) No (ADS.200)
(7) Refused (ADS.200)
(9) Don't Know (ADS.200)


ADS.180

Where did you go to be checked?

FR: READ ANSWER CHOICES ONLY IF NECESSARY.
STDWHER
(1) Private doctor (ADS.200)
(2) Family planning clinic (ADS.200)
(3) STD clinic (ADS.200)
(4) Emergency room (ADS.200)
(5) Health department (ADS.200)
(6) Some other place (ADS.190)
(7) Refused (ADS.200)
(9) Don't Know (ADS.200)

ADS.190

Where did you go to be checked?
STDWOTH Location: ____________________________


ADS.200

The next questions are about tuberculosis, or TB.
Have you ever heard of tuberculosis?
TBHRD
(1) Yes (ADS.210)
(2) No (ADS.260)
(7) Refused (ADS.260)
(9) Don't Know (ADS.260)


ADS.210

Have you ever personally known anyone who had TB?
TBKNOW
(1) Yes
(2) No
(7) Refused
(9) Don't Know


ADS.220

How much do you know about TB - a lot, some, a little, or nothing?
TB
(1) A lot (ADS.230)
(2) Some (ADS.230)
(3) A little (ADS.230)
(4) Nothing (ADS.250)
(7) Refused (ADS.260)
(9) Don't know (ADS.260)


ADS.230

How is TB spread? (PROBE: Can TB be spread in any other way?)

FR: SHOW FLASHCARD A14. MARK ALL THAT APPLY. ENTER (N) FOR NO MORE.
Card A14
You may choose more than one

1. Breathing the air around a person who is sick with TB
2. Sharing eating/drinking utensils
3. Through semen or vaginal secretions shared during sexual intercourse
4. From smoking
5. From mosquito or other insect bites
6. Other
TBSPRD
(1) Breathing the air around a person who is sick with TB
(2) Sharing eating / drinking utensils
(3) Through semen or vaginal secretions shared during sexual intercourse
(4) From smoking
(5) From mosquito or other insect bites
(6) Other
(7) Refused
(9) Don't know

[p. 49]


ADS.240

As far as you know, can TB be cured?
TBCURED
(1) Yes
(2) No
(7) Refused
(9) Don't Know


ADS.250

What are your chances of getting TB? Would you say high, medium, low, or none?
TBCHANC
(1) High
(2) Medium
(3) Low
(4) None
(5) Already have TB
(7) Refused
(9) Don't Know


ADS.260

If ADS.250 equals (5) read:
If a member of your family were diagnosed with TB, would you feel ashamed or embarrassed?

Else, read:
If you or a member of your family were diagnosed with TB, would you feel ashamed or embarrassed?
TBSHAME
(1) Yes
(2) No
(7) Refused
(9) Don't Know


ADS.270

Have you ever spent more than 24 hours living on the streets, in a shelter, or in a jail or prison?
HOMELESS
(1) Yes
(2) No
(7) Refused
(9) Don't know

[p. 88]


Section IX - DIS


DIS.010

Previously you were asked about your use of special equipment. The next questions will go into greater detail about special equipment and assistive devices. By this we mean things such as hearing aids, wheelchairs, scooters, canes, prostheses, special phones, or special computer devices. Please DO NOT include eyeglasses or false teeth.

Do you NOW use any special equipment or assistive devices to aid you in your usual activities?
DISUSEQ
(1) Yes
(2) No
(7) Refused
(9) Don't know


DIS.020

Do you know of any special equipment or assistive devices that would aid you in your usual activities, but that you do not currently have?
DISAID
(1) Yes (DIS.030)
(2) No (DIS_INTRO)
(7) Refused (DIS_INTRO)
(9) Don't know (DIS_INTRO)


DIS.030

How often do you have difficulties because you do not have this special equipment or assistive devices? Would you say always, often, sometimes, rarely, or never?
DISEQDIF
(1) Always
(2) Often
(3) Sometimes
(4) Rarely
(5) Never
(7) Refused
(9) Don't know

(Goto DIS_INTRO)
DIS_INTRO

The next questions are about your surroundings at home, school, work, or the community, and
possible barriers that might limit or prevent your activities.

FR: SHOW FLASHCARD A20

By barriers we mean things such as building design, lighting, sound, household or workplace
equipment, crowds, sidewalks and curbs, transportation, attitudes of other people, and policies.
Card A20
You may choose more than one

1. Building design (stairs, bathrooms, narrow or heavy doors)
2. Lighting (too dim to read, signs not lit, too bright, too distracting)
3. Sound (background noise, inadequate sound system)
4. Household or workplace equipment hard to use
5. Crowds
6. Sidewalks and curbs
7. Transportation
8. Attitudes of other people
9. Policies (rental policies, eligibility for services, workplace rules)
10. Other barriers

ENTER (P) TO PROCEED

(Goto DISHOME)

DIS.040

Thinking of your HOME SITUATION, do problems with any of these things on the list NOW limit or prevent your participation in home activities or household responsibilities?

FR: SHOW FLASHCARD A20
Card A20
You may choose more than one

1. Building design (stairs, bathrooms, narrow or heavy doors)
2. Lighting (too dim to read, signs not lit, too bright, too distracting)
3. Sound (background noise, inadequate sound system)
4. Household or workplace equipment hard to use
5. Crowds
6. Sidewalks and curbs
7. Transportation
8. Attitudes of other people
9. Policies (rental policies, eligibility for services, workplace rules)
10. Other barriers
DISHOME
(1) Yes (DIS.050)
(2) No (DIS.070)
(7) Refused (DIS.070)
(9) Don't know (DIS.070)

[p. 89]


DIS.050

Which ones? (PROBE: Any others?)

FR: SHOW FLASHCARD A20. MARK ALL THAT APPLY. ENTER (N) FOR NO MORE.
Card A20
You may choose more than one

1. Building design (stairs, bathrooms, narrow or heavy doors)
2. Lighting (too dim to read, signs not lit, too bright, too distracting)
3. Sound (background noise, inadequate sound system)
4. Household or workplace equipment hard to use
5. Crowds
6. Sidewalks and curbs
7. Transportation
8. Attitudes of other people
9. Policies (rental policies, eligibility for services, workplace rules)
10. Other barriers
DIHM01 Building design (stairs, bathrooms, narrow or heavy doors)
DIHM02 Lighting (too dim to read, signs not lit, too bright, too distracting)
DIHM03 Sound (background noise, inadequate sound system)
DIHM04 Household or workplace equipment hard to use
DIHM05 Crowd
DIHM06 Sidewalks and curbs
DIHM07 Transportation
DIHM08 Attitudes of other people
DIHM09 Policies (rental policies, eligibility for services, workplace rules)
DIHM10 Other barriers
(7) Refused
(9) Don't know

(Goto DIHM_CK)
Check item DIHM_CK:If DIHM = (N) or DIHM_B = () go to DIHM_11, ELSE go to DISHMOFT.
If DIHM = (97) or (99) or DIHM_B = () go to DISSCH, ELSE go to DIHM_12.
DIS.051

You can not enter N before entering any choices.
Enter (B) to backup
DIHM_11
[@] (B)

(Goto DIHM)

DIS.052

"Don't know and/or Refused" response not permitted with other answers
Enter (B) to backup
DIHM_12
[@] (B)

(Goto DIHM)


DIS.060

How often do these things limit or prevent your participation in home activities? Would you say always, often, sometimes, or rarely?
DISHMOFT
(1) Always
(2) Often
(3) Sometimes
(4) Rarely
(7) Refused
(9) Don't know

(Go to DISSCH)
[p. 90]


DIS.070

Thinking of SCHOOL, UNIVERSITY, OR CONTINUING EDICATION, do problems with any of these things on the list NOW limit or prevent you from getting training or going to school?
DISSCH
(1) Yes (DIS.080)
(2) No (DIS.100)
(3) Do not attend school/training for other reasons (DIS.100)
(7) Refused (DIS.100)
(9) Don't know (DIS.100)


DIS.080

Which ones? (PROBE: Any others?)

FR: SHOW FLASHCARD A20. MARK ALL THAT APPLY. ENTER (N) FOR NO MORE.
Card A20
You may choose more than one

1. Building design (stairs, bathrooms, narrow or heavy doors)
2. Lighting (too dim to read, signs not lit, too bright, too distracting)
3. Sound (background noise, inadequate sound system)
4. Household or workplace equipment hard to use
5. Crowds
6. Sidewalks and curbs
7. Transportation
8. Attitudes of other people
9. Policies (rental policies, eligibility for services, workplace rules)
10. Other barriers
DISC01 Building design (stairs, bathrooms, narrow or heavy doors)
DISC02 Lighting (too dim to read, signs not lit, too bright, too distracting)
DISC03 Sound (background noise, inadequate sound system)
DISC04 Household or workplace equipment hard to use
DISC05 Crowds
DISC06 Sidewalks and curbs
DISC07 Transportation
DISC08 Attitudes of other people
DISC09 Policies (rental policies, eligibility for services, workplace rules)
DISC10 Other barriers
(7) Refused
(9) Don't know

(Goto DISC_CK)
Check item DISC_CK: If DISC = (N) or DISC_B = () go to DISC_11, ELSE go to DISCHOFT.
If DISC = (97) or (99) or DISC_B = () go to DISWRK, ELSE go to DISC_12.
DIS.081

You can not enter N before entering any choices.
Enter (B) to backup
DISC_11
[@] (B)

(Goto DISC)

DIS.082

"Don't know and/or Refused" response not permitted with other answers
Enter (B) to backup
DISC_12
[@] (B)

(Goto DISC)

[p. 91]


DIS.090

How often do these things limit or prevent you from getting training or going to school? Would you say always, often, sometimes, or rarely?
DISCHOFT
(1) Always
(2) Often
(3) Sometimes
(4) Rarely
(7) Refused
(9) Don't know

(Go to DISWRK)

DIS.100

Thinking of your WORK situation, do problems with any of these things on the list NOW limit the work you do or prevent you from working?

FR: SHOW FLASHCARD A20
Card A20
You may choose more than one

1. Building design (stairs, bathrooms, narrow or heavy doors)
2. Lighting (too dim to read, signs not lit, too bright, too distracting)
3. Sound (background noise, inadequate sound system)
4. Household or workplace equipment hard to use
5. Crowds
6. Sidewalks and curbs
7. Transportation
8. Attitudes of other people
9. Policies (rental policies, eligibility for services, workplace rules)
10. Other barriers
DISWRK
(1) Yes (DIS.110)
(2) No (DIS.130)
(3) Do not work for other reasons (DIS.130)
(7) Refused (DIS.130)
(9) Don't know (DIS.130)


DIS.110

Which ones? (PROBE: Any others?)

FR: SHOW FLASHCARD A20. MARK ALL THAT APPLY. ENTER (N) FOR NO MORE.
Card A20
You may choose more than one

1. Building design (stairs, bathrooms, narrow or heavy doors)
2. Lighting (too dim to read, signs not lit, too bright, too distracting)
3. Sound (background noise, inadequate sound system)
4. Household or workplace equipment hard to use
5. Crowds
6. Sidewalks and curbs
7. Transportation
8. Attitudes of other people
9. Policies (rental policies, eligibility for services, workplace rules)
10. Other barriers
DIWK01 Building design (stairs, bathrooms, narrow or heavy doors)
DIWK02 Lighting (too dim to read, signs not lit, too bright, too distracting)
DIWK03 Sound (background noise, inadequate sound system)
DIWK04 Household or workplace equipment hard to use
DIWK05 Crowds
DIWK06 Sidewalks and curbs
DIWK07 Transportation
DIWK08 Attitudes of other people
DIWK09 Policies (rental policies, eligibility for services, workplace rules)
DIWK10 Other barriers
(7) Refused
(9) Don't know

(Goto DIWK_CK)
Check item DIWK_CK:If DIWK = (N) or DIWK_B = () go to DIWK_11, ELSE go to DISWKOFT.
If DIWK = (97) or (99) or DIWK_B = () go to DISCA, ELSE go to DIWK_12.
DIS.111

You can not enter N before entering any choices.
Enter (B) to backup
DIWK_11
[@] (B)

(Goto DISC)

[p. 92]

DIS.112

"Don't know and/or Refused" response not permitted with other answers
Enter (B) to backup
DIWK_12
[@] (B)

(Goto DIWK)


DIS.120

How often do these things limit or prevent you from working? Would you say always, often, sometimes, or rarely?
DISWKOFT
(1) Always
(2) Often
(3) Sometimes
(4) Rarely
(7) Refused
(9) Don't know

(Go to DISCA)

DIS.130

Thinking of COMMUNITY ACTIVITIES such as getting together with friends or neighbors, going to church, temple or another place of worship, movies, or shopping, do problems with any of these things on the list NOW limit or prevent your participation in community activities?

FR: SHOW FLASHCARD A20
Card A20
You may choose more than one

1. Building design (stairs, bathrooms, narrow or heavy doors)
2. Lighting (too dim to read, signs not lit, too bright, too distracting)
3. Sound (background noise, inadequate sound system)
4. Household or workplace equipment hard to use
5. Crowds
6. Sidewalks and curbs
7. Transportation
8. Attitudes of other people
9. Policies (rental policies, eligibility for services, workplace rules)
10. Other barriers
DISCA
(1) Yes (DIS.140)
(2) No (DIS.160)
(7) Refused (DIS.160)
(9) Don't know (DIS.160)


DIS.140

Which ones? (PROBE: Any others?)

FR: SHOW FLASHCARD A20. MARK ALL THAT APPLY. ENTER (N) FOR NO MORE.
Card A20
You may choose more than one

1. Building design (stairs, bathrooms, narrow or heavy doors)
2. Lighting (too dim to read, signs not lit, too bright, too distracting)
3. Sound (background noise, inadequate sound system)
4. Household or workplace equipment hard to use
5. Crowds
6. Sidewalks and curbs
7. Transportation
8. Attitudes of other people
9. Policies (rental policies, eligibility for services, workplace rules)
10. Other barriers
DICA01 Building design (stairs, bathrooms, narrow or heavy doors)
DICA02 Lighting (too dim to read, signs not lit, too bright, too distracting)
DICA03 Sound (background noise, inadequate sound system)
DICA04 Household or workplace equipment hard to use
DICA05 Crowds
DICA06 Sidewalks and curbs
DICA07 Transportation
DICA08 Attitudes of other people
DICA09 Policies (rental policies, eligibility for services, workplace rules)
DICA10 Other barriers
(7) Refused
(9) Don't know

(Goto DICA_CK)
Check item DICA_CK:If DICA = (N) or DICA_B = () go to DICA_11, ELSE go to DISCAOFT.
If DICA = (97) or (99) or DICA_B = () go to DISHFAC, ELSE go to DICA_12.
[p. 93]

DIS.141

You can not enter N before entering any choices.
Enter (B) to backup
DICA_11
[@] (B)

(Goto DICA)

DIS.142

"Don't know and/or Refused" response not permitted with other answers
Enter (B) to backup
DICA_12
[@] (B)

(Goto DICA)


DIS.150

How often do these things limit or prevent your participation in community activities? Would you say always, often, sometimes, or rarely?
DISCAOFT
(1) Always
(2) Often
(3) Sometimes
(4) Rarely
(7) Refused
(9) Don't know

(Go to DISHFAC)

DIS.160

The next questions are about access to health clubs, wellness programs or fitness facilities, such as the YMCA, community recreation programs, and employer fitness programs.
Do you NOW have ACCESS to a health club, wellness program or fitness facility that meets your needs, if you wanted to use one?
DISHFAC
(1) Yes (DIS.180)
(2) No (DIS.170)
(7) Refused (DIS.180)
(9) Don't know (DIS.180)


DIS.170

Do any of these things on the list limit or prevent your access to a health club, wellness program, or fitness facility that meets your needs?

FR: SHOW FLASHCARD A21. MARK ALL THAT APPLY. ENTER (N) FOR NO MORE.
Card A21
You may choose more than one

1. Cost is too high for your budget
2. Lack of transportation
3. Access intolwithin the building
4. Lack of exercise equipment that meets your needs
5. Lack of an instructor to show you how to use the equipment
6. Other
DISHFL01 None
DISHFL02 Cost is too high for your budget
DISHFL03 Lack of transportation
DISHFL04 Access into/within the building
DISHFL05 Lack of exercise equipment that meets your needs
DISHFL06 Lack of an instructor to show you how to use the equipment
DISHFL07 Other
(7) Refused
(9) Don't know

Which ones? (PROBE: Any others?)

(Goto DISHFLIM_CK)
[p. 94]
Check item DISHFLIM_CK: If DISHFLIM = (N) or DISHFLIM_B = () go to DISHFLIM_11,
ELSE goto DISHFUSE.
If DISHFLIM = (7) or (9) or DISHFLIM_B = () go to DISHFUSE,
ELSE go to DISHFLIM_12.
You can not enter N before entering any choices.
Enter (B) to backup
DISHFLIM_11
[@] (B)

(Goto DISHFLIM)

"Don't know and/or Refused" response not permitted with other answers
Enter (B) to backup
DISHFLIM_12
[@] (B)
(Goto DISHFLIM)

"Zero (0)" response not permitted with other answers
Enter (B) to backup
DISHFLIM_13
[@] (B)
(Goto DISHFLIM)

DIS.180

DURING THE PAST 12 MONTHS, have you USED a health club, wellness program, or fitness facility at least 10 times?
DISHFUSE
(1) Yes
(2) No
(7) Refused
(9) Don't know

Adult_End
(goto next section)